Habits, hassle, and health: how do blood donors respond to a temporary deferral due to low haemoglobin?

Abstract

This thesis explored the impact on whole blood donors of a six month deferral from giving blood due to a low haemoglobin (Hb) concentration. The aims were two-fold: first, to quantify the effect of a temporary deferral on donation patterns once eligible to return, and second, to identify the processes contributing to the effect. The mixed methods design utilised four distinct research phases: statistical analysis of donation patterns over a three year period, surveys of whole blood donors three and twelve months after deferral, and semi-structured interviews with 25 blood donors in the weeks immediately following deferral. Deferral for a low Hb increased the likelihood of non-return in both new and repeat donors, and, amongst those who did return, delayed first return, reduced donation frequency and increased the likelihood of drop-out in later years. Qualitative interviews suggested that, predominantly, individuals give blood because it represents an easy and convenient way to help others, and provides additional rewards, such as enhancing positive self-concepts and a free health check. Returning promptly after deferral appears to be related to three aspects of a person and his/her context: an individual’s other obligations, especially parenting; the extent to which donation is considered personally rewarding; and whether donation arrangements were facilitated by a range of supports prior to deferral. Over three quarters of surveyed deferred donors seek further advice and investigations from their medical practitioner and nearly half of those are encouraged to change their donation patterns. With the exception of having a low haemoglobin level confirmed at follow-up testing, experiences seeking further investigations were not associated with either intentions or return. Triangulation of findings suggests that deferral disrupts the habit of regular donation, and that this disruption makes donors more vulnerable to changes to their personal circumstances or collection practices. Deferral may also increase the perceived inconvenience of the activity, decrease self-perceptions of competence and good health, and diminish the “blood donor” identity. Practical implications of these findings are recommendations that may increase retention of deferred donors, including encouraging donors to return promptly once eligible, enhancing the convenience of blood donation, and improving aspects of the deferral event.